Practitioners who refuse Medicaid a problem for needy

Torrie Smith, 3, left, holds an apple at her home in Denver. Torrie’s parents talked about their experience getting dental treatment through Medicaid for Torrie after she fell and broke four front teeth. State Medicaid data show that fewer than half of the 453,000 Coloradans younger than 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service.

Joe Mahoney/The I-News Network

Torrie Smith, 3, left, holds an apple at her home in Denver. Torrie’s parents talked about their experience getting dental treatment through Medicaid for Torrie after she fell and broke four front teeth. State Medicaid data show that fewer than half of the 453,000 Coloradans younger than 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service.

When she was 3, Torrie Smith tripped on an uneven sidewalk, fell face down onto some steps and broke four front teeth. An emergency room doctor stopped the bleeding and gave her something for the pain, but Torrie didn’t see a dentist for six months – her first time ever – because her parents didn’t have dental insurance and didn’t have cash to pay for an examination.

Now 4, Torrie’s dental problems are so severe she has to go to an operating room, not a dentist’s chair, to have them fixed. While she is under anesthesia, an abscessed incisor will be pulled and nine other cavity-ravaged teeth will be pulled or treated.

Torrie’s toothaches, along with the risk and high cost associated with curing them, probably could have been avoided. She is like many children in low-income families in Colorado who rarely, if ever, see a dentist even though they can go for free.

State Medicaid data reported to the federal government show that fewer than half of the 453,000 Coloradans younger than 21 who were eligible for benefits in federal fiscal year 2011 received some kind of dental service. Only a quarter of Colorado counties met a 2010 state goal of getting at least 44 percent of Medicaid-eligible residents younger than 19 to visit a dentist, according to an I-News analysis of state records.

“Dental disease is not self resolving,” said Diane Brunson, director of public health for the University of Colorado’s School of Dental Medicine. “It’s not like catching a cold, and you put up with it for a week or 10 days and you’re fine. You have to get treatment. And it’s so much more beneficial all the way around – to the child, to their family, to taxpayers – if dental problems can be prevented.”

While the state appears to be making strides in improving its numbers, part of the problem is the paucity of dentists willing to see Medicaid children. Only 10 percent of Colorado’s 3,500 or so dentists are considered “significant” Medicaid providers, meaning that they are reimbursed for at least 100 visits per year. Moreover, 20 of Colorado’s 64 counties do not have a dentist who accepts Medicaid.

In total, 21 percent of the dentists report having some Medicaid patients, and only 16 percent say they are willing to accept new Medicaid patients.

Plenty of Colorado children covered by commercial dental insurance also fail to see a dentist regularly. But kids in low-income families are most at risk for tooth decay, which is the most common childhood disease.

A state health department survey released in October showed that 73 percent of third-graders in Colorado’s poorest public schools (measured by eligibility for free- or reduced-price lunches) have had a cavity compared with 41 percent of third-graders in more affluent schools. Untreated cavities affected 19 percent of kindergartners in the poorest schools, but only 7 percent in high-income schools.

Proper care of primary, or baby, teeth is just as important as adult dental care, dentists say. Baby teeth reserve space for the permanent teeth that eventually will replace them. They help in the development of speech and help give a child’s face a normal appearance.

Decaying baby teeth can make it difficult for children to chew food and can damage the permanent teeth growing beneath them. Many kids in pain end up using expensive emergency room services or undergoing multiple dental procedures while under anesthesia.

“People tend to believe that because they’re just baby teeth and they’re going to fall out, we don’t need to worry about them,” said Karen Cody Carlson, executive director of Oral Health Colorado, an umbrella group of oral health advocates. “They don’t realize that kids can get severe infections, life-threatening infections, sometimes.”

Apples are Torrie’s favorite food, but she also likes gummy fruit snacks, Sweet Tarts, chocolate and soda. In the living room of their home in Montbello, a northeast Denver neighborhood, Anthony and Wendie Smith say they thought they had been doing enough by brushing their daughter’s teeth twice a day ever since her first incisors erupted. They never took Torrie to the dentist because they didn’t have dental insurance at the time (Anthony recently became eligible through his job) and couldn’t afford the cost. Anthony, 27, is a mechanic and Wendie, 26, is a stay-at-home mom.

It didn’t occur to the Smiths, they say, that Medicaid would cover Torrie’s dental care. Wendie had qualified while pregnant and Torrie was enrolled in Medicaid as an infant. “When she came along,” Wendie says of Torrie, “they gave me a (Medicaid) card and said it was for her doctor visits. They didn’t say dental or anything like that.”

After Torrie fell on the sidewalk, the emergency room doctor told them she needed to see a dentist. Wendie says she called several around Castle Rock, where they were living then, but all wanted money up front that they couldn’t pay. Meanwhile, Torrie’s front teeth were turning black and Wendie had to cut her food into small pieces.

A friend eventually mentioned that Medicaid might help. The first dentist to see Torrie reshaped her two front teeth with porcelain, but her parents didn’t take her back for further treatment because she “didn’t feel comfortable there,” her mother says.

The Smiths found Gillespie around Halloween when a flier sent home from Torrie’s preschool mentioned that his Li’l Teeth Dentistry practice in Aurora accepts Medicaid patients. Gillespie says he treats children on Medicaid, who make up about 60 percent of his practice, because he was on Medicaid as a child. “For me, it’s very personal to make sure these kids get all the treatment they need,” he says. “Everyone deserves to be treated.”